Cost Analysis of an Antimicrobial Stewardship Program (ASP) Protocol for Adherence to the 2014 American Academy of Pediatrics (AAP) Palivizumab Prophylaxis Recommendations in a Freestanding Children’s Hospital

Abstract

BackgroundIn 2014, the AAP updated guidelines for administration of palivizumab in children at high risk of respiratory syncytial virus (RSV) disease. The updated guidelines defined high risk patient populations and recommended that eligible inpatients not receive monthly palivizumab prophylaxis but may receive a dose 24–72 hours prior to discharge. In a freestanding children’s hospital, the ASP developed a protocol that ensured compliance with the adoption of these guidelines through prospective audit of all palivizumab orders prior to medication dispensing. Review of 2 seasons of palivizumab inpatient protocol dosing was compared with historical baseline drug utilization.MethodsAll palivizumab orders required an indication that was reviewed by a pharmacist who confirmed the patient’s medical condition(s) and eligibility prior to medication dispensing. The pharmacist verbally reconciled any discrepancies with the ordering provider and if patient did not meet AAP guideline criteria, two members of the ASP reviewed the order and patient’s medical record to determine inpatient eligibility for palivizumab administration. Two RSV seasons of palivizumab inpatient dosing were compared with the baseline year prior to protocol adoption to analyze impact of the protocol on direct costs of palivizumab to the organization.ResultsTwo hundred and seventy-seven inpatient doses of palivizumab were reviewed from November 1, 2014 to April 30, 2017. After implementation of the palivizumab protocol, the number of doses administered decreased each RSV season (see Figure 1). This resulted in a decrease in drug expenditures in each of the post implementation seasons (see Figure 2). The ASP reviewed orders for 10 patients during the 2015–2016 season and 16 patients during the 2016–2017 season for unapproved indications. Hospital-acquired RSV infections remained stable after protocol implementation and isolation recommendations were unchanged.ConclusionIn a freestanding children’s hospital, an ASP driven protocol reduced palivizumab administration to inpatients in keeping with AAP guidelines while reducing direct pharmacy costs and without an increase in hospital-acquired RSV infections during the evaluation period.Disclosures All authors: No reported disclosures.